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By: Kevin Asp, CRT, RPSGT on July 22nd, 2020

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Obstructive Lung Disease vs Restrictive Lung Disease: Causes, Diagnosis, and Treatment Options

lung disease

As sleep centers receive increasingly sick patients that have much more than Obstructive Sleep Apnea (OSA), it becomes even more essential for sleep technologists to gain improved knowledge of their patients and their illnesses. This includes distinguishing between various lung conditions, such as obstructive lung disease and restrictive lung disease.

In a nutshell, obstructive lung diseases are conditions that hinder your patient’s ability to exhale all the air from their lungs. On the other hand, individuals with restrictive lung diseases have a difficult time fully expanding their lungs.  Here, you'll learn about each, including their causes, symptoms, and how they're diagnosed and treated.


Obstructive vs Restrictive Lung Disease

Watch this video snippet taken from the Advanced Sleep Titration e-Learning Course

AAST Advanced Sleep Titration e-Learning Course


What Is Obstructive Lung Disease?

Individuals with obstructive lung disease experience shortness of breath because they have difficulty exhaling all of the air from their lungs. Because of airway narrowing inside their lungs or due to damage to their lungs, exhaled air is more slowly expelled. After fully exhaling, they'll still have an abnormally higher amount of air left lingering in their lungs.

Obstructive lung disease has a number of causes with some of the most common ones including:

  • Asthma
  • COPD (Chronic Obstructive Pulmonary Disease), which includes chronic bronchitis and emphysema
  • Cystic fibrosis
  • Bronchiectasis

Obstructive lung disease makes it more difficult to breathe, particularly during enhanced exertion or activity. As the rate of breathing increases, patients have less time for exhaling completely before the next inhalation.

Causes of Obstructive Lung Disease

The primary risk factor for this condition, according to the National Heart, Lung and Blood Institute, is smoking. More than 75% of individuals with COPD either currently smoke or they used to.

Exposure to environmental lung irritants can also lead to obstructive lung disease.

Some types of lung irritants are:

  • Dust
  • Fumes
  • Chemicals
  • Excessive secondhand smoke exposure

There's also a genetic element to this condition. Individuals could develop all forms of obstructive lung disease without having substantial environmental irritant exposure or without ever having smoked.

Scientists have also found genetics can play a role in developing the condition.

For instance, some individuals have an alpha-1 antitrypsin deficiency which is a common genetic emphysema risk.

Symptoms of Obstructive Lung Disease

In the beginning, patients typically experience only mild symptoms or have none at all. As the disease worsens, more severe symptoms appear. These can include:

  • Wheezing
  • Cough that produces excessive mucus
  • Frequent coughing
  • Tightness in your chest
  • Shortness of breath, particularly with physical activity
  • A squeaky or whistling sound when breathing

Some individuals with COPD get respiratory infections like the flu and colds more frequently. COPD, in severe cases, can lead to:

  • Weakness in the lower muscles
  • Weight loss
  • Swelling in the feet, ankles or legs

How to Diagnose Obstructive Lung Disease

Physicians use a multi-faceted approach to diagnose obstructive lung disease, which includes: 

Pulmonary function testing. A pulmonary function test is performed to assist with the diagnosis of obstructive lung disease. During this test, the patient will breathe air forcibly through a mouthpiece using a few different techniques. With each technique, the volume of the air release will be recorded by a machine to determine how much air moves through the patient's lungs.

Patient history. The physician will ask the patient questions about their overall health and symptoms, which will include information on their exposure to environmental irritants like pollution and smoke and their medical history.

Physical exam. The physician performs a physical exam including listening to the lungs and checking to see if the patient has a widened, barrel chest. Wheezing, crackling, long exhalation time, and decreased breath sounds may be indicative of obstructive lung disease. 

Imaging tests. Some imaging tests may be performed, like an X-ray or CT scan of the chest. Sometimes, the physician will look at the patient's lungs with a flexible, thin lighted camera known as a bronchoscope. This procedure checks for obstructions and lung damage.

Treatment Options for Obstructive Lung Disease

Treatments for obstructive lung disease work by opening up narrowed airways. Smooth muscle spasms in the airway walls often narrow the airways causing bronchospasm.

Medication for relaxing these smooth muscles and improving airflow are known as bronchodilators.  These medications are typically inhaled and may include:

  • Formoterol (Foradil)
  • Ipratropium (Atrovent)
  • Tiotropium (Spiriva)
  • Albuterol (Ventolin HFA, Proventil HFA, ProAir HFA, AccuNeb)
  • Salmeterol (Serevent)
  • Theophylline (Theo-Dur, other brand names) taken as an oral tablet (rarely used)
  • Combined medicines like DuoNeb, Combivent Respimat, Advair and Anoro Ellipta, which include a bronchodilator

In severe life-threatening, end-stage cases of obstructive lung disease, the patient may receive a lung transplant.


Obstructive and Restrictive Lung Disease Volumes

Watch this video snippet taken from the Advanced Sleep Titration e-Learning Course 

AAST Advanced Sleep Titration e-Learning Course


What Is Restrictive Lung Disease?

Individuals with restrictive lung disease can't fill their lungs fully with air due to their lungs being restricted from expanding fully. These individuals find it difficult to take a full breath. Frequently this occurs due to a condition that causes lung stiffness, muscle weakness, or physical restriction. 

Causes of Restrictive Lung Disease

This condition often results from disorders that cause lung stiffness. In other cases, weak muscles, stiffness of the chest wall or damaged nerves could be causing the lung expansion restriction.

You can categorize restrictive lung diseases as intrinsic or extrinsic.

Intrinsic disorders come from an issue within the lungs themselves. They might include:

  • Pulmonary fibrosis
  • Interstitial lung disease
  • Sarcoidosis
  • Idiopathic pulmonary fibrosis
  • Pneumoconiosis

Extrinsic disorders cause lung issues to occur from conditions outside of the patient's lungs, meaning the lung issues and restriction originate from causes outside of the lungs. These might include:

  • Obesity
  • Scoliosis
  • Myasthenia gravis
  • Pleural Effusion

Symptoms of Restrictive Lung Disease

There are a few common symptoms with the most common being shortness of breath. In the early stages, a patient might experience shortness of breath only with exertion. As the condition progresses, the patient might begin to experience breathlessness or shortness of breath even during rest or minimal activity.

Chronic cough is another common symptom. Often the cough is dry, but it could also create white sputum. Fatigue and weight loss are also common symptoms. Many individuals find it difficult to have sufficient energy to function well and maintain a healthy weight.

Some individuals with this condition may experience symptoms of anxiety and depression. These symptoms are more common when the condition has progressed sufficiently to cause substantial limitations.

How to Diagnose Restrictive Lung Disease

A pulmonary function test is typically ordered to evaluate total lung capacity (TLC) or how much air a person's lungs take in when they inhale. The TLC is typically reduced in patients with restrictive lung disease.

Other testing might be needed for a complete diagnosis and to effectively tailor a proper treatment plan. Additional pulmonary function tests are used for determining if the restrictive lung disease is extrinsic or intrinsic.

Treatment Options for Restrictive Lung Disease

Many forms of restrictive lung diseases are progressive which means they'll become worse over time. However, there are available treatments based on the individual needs of the patient.

Some treatment options include:

1. Medications

A couple of FDA-approved medicines used for treating idiopathic pulmonary fibrosis are Ofev and Esbriet. Pulmonary fibrosis is a form of restrictive lung disease. There are other types of medications for reducing inflammation and suppressing the immune system.

These are:

  • Cyclophosphamide
  • Corticosteroids
  • Methotrexate
  • Azathioprine

2. Oxygen Therapy

Many patients use oxygen therapy to maintain their blood oxygen levels. 

3. Cellular Therapy

For patients with certain restrictive lung disease types, like pulmonary fibrosis, pneumoconiosis, idiopathic pulmonary fibrosis or interstitial lung disease, cellular therapy is an option. It works by promoting healing within the patient's lungs, possibly enhancing the function of their lungs and improving quality of life.

Under physician supervision, some patients have been able to decrease their use of oxygen therapy following treatment.

Common tests to diagnose obstructive and restrictive lung disease include:

  • Forced vital capacity (FVC) testing. This involves inhalation and filling the patient's lungs with as much air as they can, then having them exhale with force. The FVC for patients with restrictive lung diseases is usually reduced. An 80% or less FVC value of what's expected can indicate a restrictive disease. 
  • Forced expiratory volume in 1 second (FEV1) testing. This testing measures how much air is exhaled during the initial FVC testing. 
  • FVC to FEVI ratio testing. The FVC to FEV1 ratio measures how much air you can exhale in one second forcefully, relative to the total amount you can exhale. In obstructive lung diseases, this measure is reduced, but in restrictive lung diseases, it's normal. In adults, normal means a 70% to 80% FEV1/FVC ratio and in children normal means 85% or greater.
  • X-rays. Chest X-rays create images of the patient's lung area and chest for evaluation.
  • Computed tomography (CT) scans. These scans generate more detailed images of the patient's lung area and chest than X-rays, improving diagnostic utility.
  • Bronchoscopy. This entails using a flexible tube with an attached camera to view the lungs and airways.

Waiting for test results can make people anxious and cause frustration. But, there are often several steps involved in making an accurate diagnosis, since a lung disease could be either restrictive or obstructive. Obtaining an official diagnosis is essential since the distinction between these two forms of disease will ensure the patient receives the right treatment. 

Visit our Advanced Sleep Titration e-Learning Course page to learn more about obstructive vs restrictive lung disease today!

 

About Kevin Asp, CRT, RPSGT

Because of the implementation of his best practices of Implementing Inbound Marketing in its Medical Practice, he turned the once stagnant online presence of Alaska Sleep Clinic to that of "The Most Trafficked Sleep Center Website in the World" in just 18 months time. He is the President and CEO of inboundMed and enjoys helping sleep centers across the globe grow their business through his unique vision and experience of over 27 years in sleep medicine.

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